Healthcare Utilization Around the Time of Pregnancy by Extent of Disability in the U.S., 2018-2020.

Abstract

Females with disabilities have greater preconception health risks and adverse perinatal outcomes than those without disabilities. Characterization of reproductive healthcare utilization among females with disabilities in the U.S. is limited. We examined healthcare receipt before, during, and after pregnancy by extent of disability among U.S. females with recent live births. This cross-sectional study used Pregnancy Risk Assessment Monitoring System data (collected in 2018-2020 and analyzed in 2025) from 24 states that included the Washington Group Short Set of Questions on Disability. Participants self-reported healthcare visits in the year prior to pregnancy, receipt and timing of prenatal care, and receipt of a postpartum checkup. Disability was assessed as extent of difficulty (none, some, and a lot of difficulty). Associations between extent of disability and healthcare utilization were estimated using multivariable modified Poisson regression (adjusted prevalence ratios and 95% CI). Of 41,210 participants, 34.2% and 6.7% reported some and a lot of difficulty, respectively. Females with some difficulty had higher prevalence (adjusted prevalence ratio range=1.10-1.24) of not having a prepregnancy reproductive healthcare visit, any prenatal care, first trimester prenatal care initiation, and a postpartum checkup than those with no difficulty. Among females with a lot of difficulty, there was similarly elevated prevalence of not having a prepregnancy reproductive healthcare visit or first trimester initiation of prenatal care, but they had a 171% (adjusted prevalence ratio=2.71, 95% CI=1.49, 4.94) and 63% (adjusted prevalence ratio=1.63, 95% CI=1.40, 1.91) higher prevalence of not having any prenatal care and not having a postpartum checkup, respectively, than females with no difficulty. Females with some and a lot of difficulty reported lower receipt of reproductive, prenatal, and postpartum care than those with no difficulty. Strategies are needed to establish and coordinate comprehensive reproductive health care among females with disabilities.